Transient Hypocalcemia After Total Thyroidectomy: The Obesity Paradox at Work?

Remer, Lindsay F.; Linhares, Samantha M.; Scola, William H.; Khan, Zulfia; Lew, John I.

doi:10.1016/j.jss.2022.04.048

Cited by 9 publications

(3 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While this could be attributed just to missing data, this could also imply that an additional process is leading to the association we have seen in our study between BMI and postoperative PTH values. Remer and colleagues 15 recently noted a related relationship in their study of total thyroidectomy patients showing that obese patients had lower rates of transient hypocalcemia, though they did not specifically study the relationship with PTH. The results shown here counter statements suggesting that a higher BMI can increase a patients’ risk of hypoparathyroidism in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

The Obesity Paradox in Thyroid Surgery: Is Higher BMI Protective Against Hypoparathyroidism?

Fields

Ramonell

Fazendin

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

Background With a demonstrated association between adiposity and parathyroid hormone (PTH) levels, we hypothesized that patients with a higher body mass index (BMI) would have lower rates of postoperative hypoparathyroidism following total thyroidectomy. Methods retrospective review of patients undergoing total thyroidectomy from 2015 to 2021. Demographics, BMI, surgical indications, and laboratory data including pre- and postoperative PTH values were examined. Results Of the 352 patients with complete clinicopathologic data, most were female (n = 272, 77.3%) with an average age of 42.7 (SD+/−19.4). Obese (BMI 30-39.99) was most common BMI group (n = 108, 30.8%), with 11.7% (n = 41) morbidly obese (BMI > 40). Morbidly obese patients had significantly higher postoperative PTH levels than BMI < 18.5 (46.0 vs 19.3 pg/mL, P = .004). Patient race was significantly associated with pre- and postoperative PTH ( P = .03, P = .004.) On multivariable analysis, preoperative PTH, race, and BMI were independent predictors of higher postoperative PTH ( P < .05 for all). Discussion Patients with higher BMI and non-white race have relative protection from postoperative hypoparathyroidism.

show abstract

Section: Discussionmentioning

confidence: 99%

The Obesity Paradox in Thyroid Surgery: Is Higher BMI Protective Against Hypoparathyroidism?

Fields

Ramonell

Fazendin

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

show abstract

“…The surgeon's experience is not an independent predictive factor, and the surgical extension alone , the most important predictive factor. Operations performed by residents under the supervision of experienced surgeons did not have an increased incidence of postoperative hypocalcemia (Ceylan & Kesici, 2022;Remer et al, 2022;Sessa et al, 2022)…”

Section: Surgeon Experiencementioning

confidence: 99%

“…Many authors state that the incidence of postoperative hypocalcemia is inversely proportional to the surgeon's experience (Ceylan & Kesici, 2022;Remer, Linhares, Scola, Khan, & Lew, 2022;Sessa et al, 2022). The surgeon's experience is not an independent predictive factor, and the surgical extension alone , the most important predictive factor.…”

Section: Surgeon Experiencementioning

confidence: 99%

Post-thyroidectomy hypocalcemia and related complications

Al-Roubaie

2022

ijhs

View full text Add to dashboard Cite

The incidence of post-thyroidectomy hypocalcemia is high while the factors involved include age (> 50 years), type of operation, operative time, neck dissection, histology of the surgical specimen and vocal fold paralysis. Low ionic calcium concentrations are indicative of the presence of symptoms of hypocalcemia and the need for oral calcium. Progression to definitive hypoparathyroidism occurs only in patients with clinical manifestations of post-thyroidectomy hypocalcemia. In general, the problem with post-surgical hypoparathyroidism resides in the surgical procedure itself. The most common are related to neuronal hyperexcitability, which explains the paresthesias, cramps and numbness, which usually start in the perioral region and on the fingertips. Muscle spasms and muscle stiffness are also common. When severe, hypocalcemia can lead to life-threatening spastic tetany, laryngospasm, and seizures. The current manuscript aimed to present a review of the bibliography on thyroidectomy and negative impact of its complications on human health, mainly because of a higher risk for developing hypocalcemia. To achieve the study goal, this review covered most recent published articles from 2017 onward.

show abstract

Association of obesity and thyroidectomy‐specific perioperative outcomes

Memeh,

Abou Azar,

Afolaranmi

et al. 2024

World j. surg.

View full text Add to dashboard Cite

BackgroundThere is limited large‐scale data on the effect of obesity on thyroidectomy‐specific outcomes. To fill this gap in the literature, this study evaluates the association between obesity and thyroidectomy‐specific outcomes using a large real‐world surgical outcomes dataset.Materials and MethodsThe 2016–2019 American College of Surgeons National Surgical Quality Improvement Program Targeted Thyroidectomy dataset (ACS NSQIP) was queried. Using an inverse probability weighted (IPW) model, the impact of BMI on the primary (postoperative voice hoarseness, neck hematoma, and hypocalcemia.) and secondary outcomes (operative time and postoperative length of stay) were estimated. BMI was evaluated as per the WHO obesity categories. Sensitivity analysis was performed.Results24,370 patients were evaluated with an average BMI of 30.6, a mean age of 51.8 years, 77.5% were female, and 7.9 % were Hispanic. In univariate analysis, patients with BMI >30 had a higher risk of postoperative voice hoarseness (6.7 vs. 5.8% and p = 0.005) and neck hematoma (2.1 vs. 1.7% and p = 0.014) and a lower risk in hypocalcemia rates (3.6% vs. 4.6 % and p < 0.001). In the fully adjusted multivariable IPW models, BMI >30 was associated with a higher rate of postoperative voice hoarseness (RR 1.12 and p = 0.031) and neck hematoma (RR 1.25 and p = 0.024) but a lower rate of hypocalcemia (RR 0.81 and p = 0.001). Also, patients with BMI >30 had longer OR time (adjusted difference: 6.33 min and p < 0.001) and length of stay (adjusted difference: 1.36 h and p = 0.002).ConclusionIn this national cohort of patients undergoing thyroidectomy, obesity was associated with a decreased rate of hypocalcemia but an increased rate of postoperative voice hoarseness and neck hematoma.

show abstract

Transient Hypocalcemia After Total Thyroidectomy: The Obesity Paradox at Work?

Cited by 9 publications

References 30 publications

The Obesity Paradox in Thyroid Surgery: Is Higher BMI Protective Against Hypoparathyroidism?

The Obesity Paradox in Thyroid Surgery: Is Higher BMI Protective Against Hypoparathyroidism?

Post-thyroidectomy hypocalcemia and related complications

Association of obesity and thyroidectomy‐specific perioperative outcomes

Contact Info

Product

Resources

About